title: Biliary metal stents are superior to plastic stents for preoperative biliary decompression in pancreatic cancer.
abstract: BACKGROUND
  It is unclear whether plastic or metal stents are more suitable for preoperative biliary decompression in pancreatic cancer. The objective of this study was to compare the rate of endoscopic reinterventions in patients with pancreatic cancer undergoing plastic or self-expandable metal stent (SEMS) placements for preoperative biliary decompression.
  
  
  METHODS
  This was a retrospective study of all patients with obstructive jaundice secondary to pancreatic head cancer who underwent their index endoscopic retrograde cholangiopancreatography (ERCP) and all follow-up biliary stent placements at our center before undergoing pancreaticoduodenectomy. Plastic or SEMS were placed at ERCP for biliary decompression. The main outcome measure was to compare the rate of endoscopic reinterventions between the plastic and SEMS cohorts.
  
  
  RESULTS
  29 patients who underwent pancreaticoduodenectomy had preoperative biliary stent placement (18 plastic, 11 SEMS) at our center. Whereas none of the 11 patients who underwent SEMS placement had stent dysfunction, 7 of 18 (39%) patients with plastic stents required endoscopic reintervention before surgery (P=0.02). Reinterventions were due to cholangitis (n=1) or persistent elevation in serum bilirubin levels (n=6). Two patients with SEMS underwent EUS-guided fine-needle aspiration after ERCP, which yielded a positive diagnosis of cancer in all cases; SEMS did not impair visualization of the tumor mass at EUS. Pancreaticoduodenectomy was undertaken successfully in all 29 patients and the presence of a SEMS did not interfere with biliary anastomosis. On univariate logistic regression, only SEMS placement was associated with less need for endoscopic reintervention (P=0.02).
  
  
  CONCLUSIONS
  SEMS are superior to plastic stents for preoperative biliary decompression in pancreatic cancer.
authors.affiliation: Division of Gastroenterology-Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Decker
authors.forename: John D
authors.initials: JD
authors.lastname: Christein
authors.forename: Milind A
authors.initials: MA
authors.lastname: Phadnis
authors.forename: C Mel
authors.initials: CM
authors.lastname: Wilcox
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D019299:Decompression, Surgical / Q000295:instrumentation; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D010969:Plastics; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents
chemical_list: D008670:Metals; D010969:Plastics